Pain Is Not a Symptom of PCOS

PCOS painAccording to a 2017 study, pain is the most frequently reported symptom of PCOS. Despite the fact that pain is not a symptom of PCOS.

The solution to this paradox is that both PCOS and period pain are common so it’s easy to have both a PCOS diagnosis and period pain (including pain due to endometriosis).

That’s true whether the PCOS diagnosis is valid (i.e. there are symptoms of androgen excess) or invalid (the diagnosis was mistakenly based on an ultrasound finding).

PCOS cannot be diagnosed by ultrasound

Having polycystic ovaries does not mean you have the hormonal condition PCOS. It actually does not mean anything at all. Why? Because polycystic ovaries are follicles or eggs, which are normal for the ovaries.

👉🏽Tip: You have more eggs when you’re younger, so you’re more likely to have “polycystic ovaries” when you’re younger. “Polycystic” really just means “many eggs,” and more specifically, it means there is no evidence of ovulation in that cycle (and therefore no dominant follicle)—but says nothing about how likely ovulation will be in a future cycle. In fact, ovulation is very likely in a future cycle because many women outgrow PCOS.

Polycystic ovaries can show up on an ultrasound when:

  • you’re perfectly normal.
  • you have hypothalamic amenorrhea,
  • you have the hormonal condition PCOS, or
  • you have a  gynecological condition such as endometriosis, or adenomyosis, or any number of other issues that cause pain.

👉🏽 Tip: Polycystic ovaries are different from ovarian cysts, which are abnormal structures that can burst and cause pain. Ovarian cysts are not polycystic ovaries.

PCOS is a whole-body hormonal (endocrine) condition

PCOS is the endocrine condition of having high androgens or male hormoneswhen all other causes of high androgens have been ruled out. It’s not a gynecological disease affecting the female reproductive organs.

Effective treatment for PCOS is to lower androgens with strategies such as metformin, spironolactone, and cyclic progesterone therapy.  For natural treatment ideas, see Chapter 7 of Period Repair Manual and Treatment for 4 types of PCOS and note that some PCOS treatments will coincidentally improve mild period pain (even though they weren’t prescribed for that) but can usually do nothing for severe pain.

Effective treatment for pain is to identify the cause of pelvic pain and treat that.

Possible causes of pelvic pain include:

  • primary dysmenorrhea (normal period pain)
  • endometriosis
  • adenomyosis
  • fibroids
  • ovarian cysts
  • interstitial cystitis
  • STDs and PID
  • pelvic floor dysfunction
  • digestive problems.

If your period pain is “normal period pain,” it should respond to simple treatments such as zinc and dairy-free diet. In fact, if it doesn’t respond to those simple treatments, it’s not “normal period pain” it’s severe pain, possibly due to endometriosis, and you should see your doctor.


Finally, yes. The pill can suppress the symptoms of both PCOS and period pain, but it cannot fix either problem.

Ask me in the comments.

Dr Lara Briden

49 thoughts on “Pain Is Not a Symptom of PCOS”

  1. Hi Lara, I’m trying to figure out what I have. PMDD calls to me, and I might have endometriosis and/or PCOS as well. I kind of skipped over the pcos part in the book because despite everything else, my periods were always regular. But I may have inflammatory pcos… i have the most severe pain ever before and in the beginning of my cycle. I also had SIBO last year, have Celiac disease; and the thing that started me on this long journey was unexplained joint pain and nerve pain… I’m really quite at a lost. Someone suggested I see an endocrinologist. All the other doctors push birth control or antidepressants. I’m quite tired of it. I’ve got chronic fatigue and brain fog and I just can’t function half the time.

  2. I have PCOS and can absolutely say that the pain I’ve experienced from cramping with cysts, from constant pelvic pain, from rectal pressure, etc have all been symptoms of my PCOS. I feel like the medical community seems so sure of things they dont understand.

  3. Hello Lara ma’am, I am facing problem with irregular period and facial hair growth so I went to the Dr. For my facial hair growth treatment,then Dr. Told me that you have to do sonography to check pcos or pcod, she suggest me that pelvic and abdomen sonography so I did my sonography then my report shows that left ovary is 4cm increased and possibility of pcos so I go to endocrinologist, he suggest me some tests like FSH, TT,DHEAS,TSH my hormone report is normal these are under control of range, I diagnsed with ovarian cyst, he told me that it will decrease by pills and if your pain is increased then we will do operation. So my point is can you please suggest any food diet or exercise to regulate my period and cyst decrease, and also how to control facial hair growth please let me know about this I am tired of facial hair growth and irregular period problem. Thank you for your blog🙏

  4. I wonder if you have some research works. You are so sure about things you have never experienced. I have PCOS whole the life same as all my family, including men. I am 52. When cysts started to grow in 40, I got pain until the one was operated and taken out. Since then I do not have pain. Hashimoto thyroiditis also was accompanying until the cystic ovaria was operated. After that thyroiditis healed itself.

  5. Insulin resistance is caused by the storage of fat in tissues that are not designed to store fat. It’s fat, not sugar. Eating a no or low sugar diet is only addressing the symptoms, not the cause. It actually only makes the condition worse.

  6. Hi Lara! I read your book and loved it. I wanted to know your take on Chinese medicine. I recently took some for 3 months and then noticed that I was not responding as well as I was to fertility drugs. In addition, I was also lax about taking Metformin 3 x a day. Do you recommend it to your patients? I was taking a potent mix with cordyceps , wild ginseng, peonies and more. Also, I did the fasting glucose test but the first hour was high and the second hour was normal. Does that still count as PCOS insulin Resistant type?


  7. I have PCOS and have had a cyst rupture multiple times and have been hospitalized. I had internal bleeding and emergency surgery. So if not a cyst what ruptured then., I have had it since I was 17 and am now 27,don’t tell me its not painfull. If your not a OBGYN or have never had PCOS you have no idea what you are talking about. Cysts form in the egg folicals when you don’t ovulate.Some women who suffer from this have pain until a cyst ruptures then they have relief. Others, like me are always in pain and that pain increases when I have a rupture to the point I cannot sit or stand and have to be rushed to the emergency room. Pcos is a hormonal condition that causes multiple cyst to form in ovarian folicals when ovulation does not happen. I have had about 2-3 transvaginal ultrasounds a year since I was 17. The pain I feel changes throught the month but its almost always present.

    • as I explain in the blog post, it’s possible to have both ovarian cysts (the kind that rupture) and the hormonal condition PCOS.
      But “polycystic ovaries” are not ovarian cysts.

  8. Interesting blog, good information is provided regarding polycystic ovarian syndrome period pain. Was very useful, thanks for sharing the blog.

  9. I have pcos… I was told that i have polycystic ovaries… And i am in pain everyday… They said polycystic ovaries not ovarian cyst…. Okay.. So u say it doesnt cause pain. When you dont ovulate.. It creates the follicles to stay and attach to the ovaries after so long it keeps building causing your ovaries to become enlarged…. So ur saying that and enlarged overies wouldnt be painful? If u catch pcos at the very beginning no u wont have pain… But its hard to find u have pcos until u start showing symptoms such as hair growth weight gain and .. Wait for it… Pelvic pain. This is the kind of articles that scare women into thinking they have cancer or start over thinking there symptoms… I have a specialist in endometriosis she has studied this for yearrrrs and told me that yes pcos can be painful. The cyst themselves may not but that’s not the only thing that happens. The cyst cause ur ovaries to become enlarged. Enlarged ovaries are a symptom of pcos.. And it is painful. Please do more research on a condition before writing articles when u clearly dont fully understand what u are talking about.

  10. Pain isn’t a symptom? Clearly, you don’t have PCOS and have absolutely no clue what you are talking about. Maybe if you have no idea what it actually feels like to live with this condition you shouldn’t be writing articles on the internet about things you know nothing about. Seriously!
    Walk one month in my shoes and tell me pain isn’t a symptom! Women without PCOS, without cysts and that have normal cycles have absolutely no clue what it’s like, what it feels like or how debilitating the pain can truly be.

    • Ovarian cysts can cause pain, but polycystic ovaries are not ovarian cysts.
      And the hormonal condition PCOS does not include ovarian cysts or pain as a symptom.
      All that said, it is possible to have pain AND the hormonal condition PCOS. But the pain is a separate issue.

  11. I do not have pcos. I had a history of mucinous cyst in ovary which was operated 6 years back. Right now i have regular periods, regular bleeding etc. But at times my periods are painful. Could you please advice what could be the reason.

  12. I have PCOS, once experienced severe pain in my right ovary. I remember seeing a student doctor and he kind of scoffed at my thinking it was my ovary, proved him wrong though when an ultrasound revealed that a ruptured cyst had burst a blood vessel and I was bleeding internally. It was only minor bleeding, but it explained the pain, has happened twice since being diagnosed – currently my PCOS is not ‘active’ as I’m on a ketogenic diet.

    • Thanks for sharing your story. Just to clarify: Ovarian cysts can cause pain (especially if they rupture), but ovarian cysts are not the same thing as the hormonal condition polycystic ovarian syndrome.

  13. Hi Laura,

    I recently purchased your Period Repair Manual and really enjoy it! Thanks for putting all your time and effort into a manual to help so many of us that struggle with our health.

    I have PCOS and already don’t eat any gluten and skip dairy most of the time. I do however miss whey protein options for shakes and bars when traveling. Does whey cause inflammation as well for PCOS patients?

    Thank you!

  14. Hello Lara, please pleaseeee reply, I am having awful days:

    I am a 24-year-old virgin girl from Iran, and I’ve been diagnosed with PCOS since I was 15. For 7 years, I consumed “birth control” pills, which I finally thought might be a risk, so I stopped and asked my doctor to really do something about it!

    The surprising part is even after stopping the pills, no symptoms that are regular for women with PCOS ever happened to me. I am 45 Kilograms, I work out regularly (a big fan of TRX!) I have no acne, no abnormal facial hair (any masculine kind of hair in any part of my body), estrogen, progesterone, testosterone levels are all normal according to my tests. Prolactin level is normal. FSH, TSH levels are normal. Everything is literally normal “EXCEPT” LH which is a little bit high, and THE MOST ANNOYING PART: I don’t get period…

    Although my hormone levels are normal, doctor gave me doses of progesterone (oral and injection) for 3 months in order to get my period back, but nothing happened. Doctor added metformin, still nothing happened at all!

    Finally, doctor decided to combine estrogen and progesterone pills. which means: “21 tablets of conjugated estrogens + 20 tablets of medroxyprogesterone for the last 10 days + metformin” every month, which finally helped me get my period back (but only if I use them regularly every month).

    But this is driving me really crazy.
    Since my symptoms are totally different from the ones that are expected, how can I really stop the PCOS?! I’m not even sure what type it is!
    I am stressed that I might even have issues later if I ever decide to get pregnant in my 30s.

    I know this was really long and my English may not be good, but I do really wish you notice my comment,and reply.

  15. Hi Lara,
    after how many months of not ovulating would you suggest inducing a period, and how should you do this? I’m currently at 5 months and although I’ve learned that the missing ovulations are worse than the missing periods, I’m a little bit concerned about the long time with no bleeding… Also, can you suggest a list of hormones to check that I can give to my doctor because we aren’t getting behind the cause of my lack of ovulations (besides the elevated testosterone). I would really appreciate this.

  16. Hello Lara,
    I have been reading your blog for some years and have found it helpful and fascinating. I have been diagnosed with PCOS and have successfully been treating it by adhering to your gluten free, A2 diary, and refined sugar free diet. Because of this, I now have periods every 25/26 days and am at a normal weight. I am TTC and it doesn’t seem to be working. I have been using the ovulation predictors and they are not spiking for me, but I do have a regular bleed and my cervical mucus indicates ovulation. What would you guess might be an underlying cause? Is my LH not spiking or am I not ovulating? I do have a high stress job (teaching high schoolers) and my blood pressure is elevated during the school year.

    • A better way to detect ovulation is to track your temperatures. Have you tried that?
      And if you are ovulating, your next step is for your partner to have a sperm test. (And when you get his result, please look closely at the parameters including “sperm morphology.”) If you’re ovulating but not managing to conceive, there’s more than a 50% chance that it’s a male issue.

  17. Hi Lara, I’ve been vegan my whole life and get regular periods! I messaged you on Instagram, looking forward to hearing from you.

  18. What do you think about taking cortisone against elevated testosterone? I have very long and irregular cycles (and I’ve always had) but I have no other health problems. My doctor checked everything and I only have slightly too much testosterone, everything else is fine. Also, I was able to rule out every possible cause of PCOS that you wrote about in your book (because I thought that I might have PCOS, but I’m not so sure anymore).
    My doctor suggested I could take the pill or just do nothing, but I have read that cortisone could be another option. Do you know something about this treatment?

    I’d be so happy if you could answer this. Many thanks

      • It’s my testosterone that is high, I don’t think she said anything about my adrenal hormones so I think they are normal. So that means cortisone wouldn’t be the right treatment?

        She didn’t test insuline but I took myo-Inositol for 6 months and ate almost no sugar during this time (only whole fruits) but I didn’t see any results which is why I assume I can’t have insulin resistance.

  19. Hi Lara!

    I have recently come across your blog and read your new book and I just wanted to say thank you so much for all of the wonderful in depth research and time you have put into this topic. All of the information has been so helpful and eye opening for me as I have recently come off of the birth control pill after 10 years of use. I have only been off the pill for 3 months and have had extremely regular cycles (28-29 days) but seem to be suffering from really delayed ovulation and short luteal phase as confirmed by temperature and OPK tests. Do you see this a lot and think my body just needs more time to adjust? Or do you think a supplement like magnesium or zinc like you commonly recommend would help? Any response or thought would be greatly appreciated!

    Thanks so much again for providing so much information on a topic that is so important to women!ra

    • Hi Rachel, Thanks for your feedback about my book. It’s still early days and I expect your luteal phase will improve. Especially if you’re healthy and fully nourished and younger than 40.

  20. “This article is worth reading for every woman as we have been hearing so much about PCO’s these days. The way you have comprehended it and cleared the related doubts I am sure it will bring peace to most of the affected and confused readers. Well done..!!

  21. I was determined to have PCOS (polycystic ovarian syndrome) in the wake of endeavoring to consider for over a year. I was put on metformin which made me unpleasantly sick all the ideal opportunity for an entire year and still did not ovulate which implied despite everything I couldn’t imagine. I did a huge amount of research and began discovering little approaches to attempt and adjust my hormones normally, without prescription.

  22. I was diagnosed with PCOS after trying to conceive for over a year. I was put on Metformin (which made me horrible nauseous ALL THE TIME) for a full year and still did not ovulate which meant I still could not conceive. I did a ton of research and started finding little ways to try and balance my hormones naturally, without medication. I am just now starting a trial of the herb Tribulus (found within this article here: to try and help, no luck yet, but fingers crossed!

    Any thoughts on having a “Enlarged Ovaries” ?. This is what they found on my ultrasound- surprisingly no cysts (still unclear why its called poly-cystic). Doctor said it didn’t mean much except maybe my body could be producing excessive hormones- which I did have the common high testosterone.

    Thanks in advance for any further info you may have!!

  23. I am currently awaiting a Gynaecology appointment as a cyst was detected on my left ovary (second time a cyst has shown on a scan). I had my left tube removed due to a ruptured ectopic (3 years ago) and ever since then I have been really struggling with irregular periods, depression, bad skin, flaky/itchy scalp, tiredness etc. (I could go on) when I never had any of these issues before. I also have months where on the first day, or the day before, of my period I have excruciating abdominal pain and sickness, where pain killers don’t help to relive the pain. I have informed doctors of the symptoms and the pains but am told to wait until I am seen by the hospital.
    My worry is that I get to the hospital, have tests, and nothing is detected. Could this be possible? I personally think that the issues I have are when I ovulate (or try to) on the left side, which causes the cyst and symptoms. I am a little worried that if I ovulate on my right and have none of the above, then nothing will show up to help me.

  24. Thanks for this, I fit into this category of someone who was ‘diagnosed’ with PCOS at a young age but it doesn’t seem to be an accurate description anymore.

    I have regular periods, but in the last 6 months have started spotting on day 10-11 of my cycle. I ovulate usually at day 17 so I don’t think it’s ovulation spotting. I’m not sure what this could be related to, as there seems to be a lot of information about spotting in the luteal phase but not the follicular phase?

      • I have spoken to a doctor who offered the pill as a solution. I had a pelvic ultrasound recently which was all clear, and my hormone tests seem to be mostly normal except low progesterone, so I’m not sure what it could be.

  25. Hi Lara, my zinc levels haven’t increased despite constant supplementation. I have been taking 30mg for more than 2 years. My zinc levels are still low. I don’t eat much phytic acid so that shouldn’t be obsurring absorption. Any ideas?

        • First of all, are you measuring serum zinc? It’s not a terribly reliable test and can be affected by many things such as whether you were fasting or not. (Zinc is higher after a fasting test because of zinc released by the muscle tissue.) Also, it really only reflects your current status that day and will probably depend on when you do the test compared to when you took the supplement. The body doesn’t store zinc so it’s not possible to build up levels like it is with iron, for example. I do occasionally test for zinc but I’m starting to just give a daily dose according to symptoms.

        • All that said, a liquid is usually better absorbed and you could think about whether your zinc absorption is being impaired by gluten or dysbiosis. The Pill is another cause of poor zinc absorption but I assume that’s not your situation.

  26. I have been diagnosed with both PCOS and adenomyosis. How ever I have not found any trustworthy information on adenomyosis and what I can do to help deal with it. When I had an operation to sort out my “issues” the diagnosis was given to me while coming out of anaesthetic and that was it. Have you written more about this problem or can you please direct me to a reliable source. Thank you, I really enjoy your blog.

    • I discuss adenomyosis in Chapter 9 of my new book. It has similarities to another condition called endometriosis and the treatment is similar. I also hope to write a blog post about it soon.

  27. Is there a place we can all go to suggest /petition a name change?

    It seems like the name alone can cause misunderstanding, misdiagnosis and further trouble for these poor women suffering.

    • A new name is coming. One of the proposed names is “anovulatory androgen excess.” Maybe AAE for short?

      And yes, it will be SO good to shift the focus from the ovaries and the ultrasound finding.


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